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1336788850 NPI number — TRACY KAY O'SHEA APRN-CNP #58842

NPI Number: 1336788850
Health Care Provider/Practitioner: TRACY KAY O'SHEA APRN-CNP #58842

Information about “1336788850” NPI (TRACY KAY O'SHEA APRN-CNP #58842) exists in 1336788850 in HTML format HTML  |  1336788850 in plain Text format TXT  |  1336788850 in PDF (Portable Document Format) PDF  |  1336788850 in an XML format XML  formats.

NPI Number : 1336788850 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336788850",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "O'SHEA",
    "FirstName": "TRACY",
    "MiddleName": "KAY",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "APRN-CNP #58842",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOHNSON",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": "KAY",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4520 MARTINSBURG RD NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87120-3857",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-385-4981",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2211 LOMAS BLVD NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87106-2719",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-272-2111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/31/2019",
    "LastUpdateDate": "06/14/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "58842",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "R64921",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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